Table 4 Originally planned implementation support

Step 1. Create an ‘SDH Team.’

Materials for clinic leaders: benefits of SDH documentation / action; leaders’ role in supporting SDH process adoption

Recruit, designate, train for leadership; orientation materials

Materials for clinician champion: orientation, step summary materials

Obtain leadership support.

Materials for project champion: orientation, step summary materials

Draft email from leadership to clinic staff alerting staff to SDH Plan

Technical assistance

Identify, orient clinic champion / study contact.

Office hours covering: (1) Orienting champions; (2) Goal setting

Identify / prepare champions; recruit, designate, train for leadership; orientation materials; peer-to-peer learning

Check-in: Orientation

Technical assistance

Step 2. Identify goals.

Materials - Decision tools: Why do you want to collect SDH data? What do you hope to accomplish? What do you plan to do with the SDH data? Which patients do you want to screen? How often? For which SDH?

Goal identification / implementation blueprint

Materials - Written recommendations / key considerations for selecting clinic goals

Goal identification; technical assistance

Identify clinic’s goals for SDH screening.

Summary of the clinic’s stated goals

Goal identification

Office hours covering: (1) Goal setting; (2) Learning the EHR tools

Goal identification / implementation blueprint; peer-to-peer learning

Identify which patients will be screened for which SDH measures.

Check-in: Identify goals

Goal identification / implementation blueprint

Step 3. Create an ‘SDH Plan.’

Materials - Planning tools: SDH documentation workflow; SDH data review / action workflow; Workflow implementation rollout

Technical assistance

Materials - Resource list (PRAPARE, HealthLeads, etc.)

Create a workflow plan for SDH documentation, and (if desired) SDH data review and action.

Materials - Guides to using EHR’s SDH Data Tools: In workflows; in SDH documentation, on site or via patient portal; to review SDH; for SDH referral-making (with guidance on creating a social service resource list)

Materials - Pros and cons of different SDH documentation workflow options; key considerations based on other CHCs’ experience

Create a rollout plan.

Materials - Summary of clinic’s stated workflow plan

Goal identification / implementation blueprint; technical assistance

Check-in: Workflow development, use of workflow planning tools, rollout plan

Technical assistance

Office hours covering: (1) Workflow planning; (2) EHR tools within workflows

Peer-to-peer learning; technical assistance

Step 4. Train clinic staff.

Materials - Orientation webinar for clinic staff; review clinic’s goals and workflow plan; include staff discussion of potential barriers / how to address them.

Educational meeting / materials; goal identification

Orient staff.

Materials - How to orient clinic staff to SDH documentation and action, based on other CHCs’ experiences

Educational meeting

If SDH plan changes, orient staff.

Materials - Template slides / handouts for updating staff and / or training new staff

Educational meeting; technical support

Check-in: How to train staff

Train new staff as needed.

Office hours covering: (1) How to train staff; (2) How to create target population reports and adoption reports

Peer-to-peer learning; technical assistance

Step 5. Roll out the ‘SDH Plan’

Materials - Guides: Using SDH Data Tools to review SDH documentation / action data; Using SDH documentation data to track progress; Testing workflows; PDSA cycles

Audit and feedback

Review adoption rates on a regular basis.

Check-in: Develop strategy for testing workflows, addressing barriers, rollout, review of adoption progress; how to track SDH adoption progress using data tools; how to revise workflows, rollout plan as needed

Audit and feedback; technical assistance; practice facilitation / small tests of change; tailor strategies

Data - monthly adoption reports

Audit and feedback; tools for quality monitoring

Iterate / revise rollout, workflows as needed.

Office hours covering: How to iterate and refine workflows; other topics identified as needed by the clinics or the IST

Peer-to-peer learning; technical assistance; ongoing consultation